Chem Path Flashcards
Drug causes of hyperkalaemia
potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin
Cushing’s like symptoms with a normal dexamethasone suppression test
Chronic alcohol abuse
Erratic blood glucose control, bloating and vomiting
Gastroparesis
hypothyroidism + goitre + anti-TPO
Hashimoto’s thyroiditis
Every person treated with insulin should have a … for emergencies
Glucagon kit
Thyroid cancer, increased calcitonin
Medullary
An elevated TSH with normal T4
Subclinical hypothyroid
can cause fluid retention and is therefore contraindicated in patients with heart failure.
Pioglitazone
Management for subclinical hyperthyroidism
Repeat TFTs in a few months
First line management for painful diabetic neuropathy
amitriptyline, duloxetine, gabapentin or pregabalin
Amytryptiline contraindicated in BPH, may cause urinary retention
Management for post menopausal women who has had a fracture
Risedronate and calcium supplements
First line management of newly diagnosed T1DM
basal–bolus using twice‑daily insulin detemir
best test to diagnose Addison’s disease
Short SynACTHen
Test to confirm Phaeochromacytoma
24 hr urinary metanephrines, not catecholamines
Bleeding gums: which vitamin deficiency
vitamin C
Diarrhoea, confusion, eczematous skin. Which vitamin deficiency
Niacin
When to add another drug (to metformin) for T2DM
if the HbA1c has risen to >= 58 mmol/mol (7.5%)
Men 1, Men 2a, Men 2b
Men 1: 3 Ps: Parathyroid, Piruitary, Pancreas. Men 1 gene, commonly presents as hypercalcaemia
Men 2a: 2Ps: Parathyroid, Phaeochromacytoma, Medullary thyroid cancer. RET oncogene
Men 2b: Phaeochromacytoma, medullary thyroid cancer, marfanoid body, neuromas. RET oncogene
osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone
Hyperparathyroidism
confusion, drunken like state in patient taking quinine
Hypoglycaemia
bone complication of long term prednisolone use
avascular necrosis
First line Rx for cerebral metastasis
Dexamethasone, reduces cerebral oedema
Diabetes diagnosis:
Fasting glucose >7.0
Random glucose >11.1
IF ASYMPTOMATIC, DO 2 READINGS
useful in T2DM patients who are obese (in addition to metformin)
Gliptins
Investigation needed for someone on carbimazole who is unwell
FBC - rule out agranulocytosis
Expected TFTs for sick euthyroid syndrome
Normal/low TSH, Low T3 and T4
In sick euthyroid syndrome (now referred to as non-thyroidal illness) it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the normal range (inappropriately normal given the low thyroxine and T3).
Thyroid nodule, FHx of thyroid disease and difficult to manage hypertension
Medullary thyroid cancer (commonly also have a phaeochromacytoma, explaining the hypertension)
Several thyroid nodules, clinically euthyroid, young woman
Papillary carcinoma, commonly have lymphatic spread
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
Hypercholesterolaemia rather than hypertriglyceridaemia
Nephrotic syndrome
hypothyroidism
Cholesystasis
Expected bloods (Potassium, acid-base) for Cushing’s disease
Hypokalaemic metabolic alkalosis
Decreased secretion in reduce to stress (surgery)
Insulin
Testosterone
Oestrogen
t2dm patient, on insulin. What HbA1c threshold to add another drug
58mmol/mol (7.5%)
ECG changes associated with hypocalcaemia
Corrected QT interval prolongation
Drug causes of hyperprolactinaemia
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids
In type 1 diabetics, a general HbA1c target of… should be used
48mmol/mol
Deficiency of which electrolyte can cause calcium deficiency
magnesium, needed for calcium absorption (helpss PTH activity)